Barriers and perceptions regarding code status discussion with families of critically ill patients in a tertiary care hospital of a developing country: A cross-sectional study

Background: In Asian societies including Pakistan, a complex background of illiteracy, different familial dynamics, lack of patient’s autonomy, religious beliefs, and financial constraints give new dimensions to code status discussion. Barriers faced by physicians during code status discussion in these societies are largely unknown.Aim: To determine the barriers and perceptions in discussion of code status by physicians.Design: Questionnaire-based cross-sectional study.Setting and participants: This study was conducted in the Department of Medicine of The Aga Khan University Hospital, Karachi, Pakistan. A total of 134 physicians who had discussed at least five code statuses in their lifetime were included.Results: A total of 77 (57.4%) physicians responded. Family-related barriers were found to be the most common barriers. They include family denial (74.0%), level of education of family (66.2%), and conflict between individual family members (66.2%). Regarding personal barriers, lack of knowledge regarding prognosis (44.1%), personal discomfort in discussing death (29.8%), and fear of legal consequences (28.5%) were the top most barriers. In hospital-related barriers, time constraint (57.1%), lack of hospital administration support (48.0%), and suboptimal nursing care after do not resuscitate (48.0%) were the most frequent. There were significant differences among opinions of trainees when compared to those of attending physicians.Conclusion: Family-related barriers are the most frequent roadblocks in the end-of-life care discussions for physicians in Pakistan. Strengthening communication skills of physicians and family education are the potential strategies to improve end-of-life care. Large multi-center studies are needed to better understand the barriers of code status discussion in developing countries

Compact Polarization Diversity Antenna for 28/38 GHz Bands

In this paper, design and analysis of a millimeter wave dual- and dual-polarized antenna for 5G millimeter communications system is presented. The proposed design has a compact structure with size of 5 × 5 mm 2 . It consists of a rectangular patch with a crossed-slot etched off in the patch to reduce the interference between the two targeted 5G bands of 28 and 38 GHz. To achieve dual polarization performance, the radiating patch is fed by two different 50-Ω microstrip transmission lines. The antenna has -10dB impedance bandwidths of 2.6GHz (26.8-29.4 GHz) and 2.5GHz (37.7-40.2GHz) to cover 28/38 GHz mobile communication bands respectively. The antenna has the merits of miniaturized dimensions, stable broadside radiation patterns with high gains and low cross polarization in both bands of operation

Medical thoracoscopy- an experience

Background: Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating pleural diseases especially undiagnosed exudative pleural effusion. It is cost effective and safe. The diagnostic yield in undiagnosed pleural effusion is excellent.Methods: This prospective observational study was done in Government Chest Disease hospital of Government Medical College, Srinagar during the period between December 2015 to Dec 2016.Thirty undiagnosed pleural effusion patients after thoracocentesis and who fulfilled inclusion and exclusion criteria’s were included in the study. Medical thoracoscopy using rigid thoracoscope was started for the first time in our hospital and was done in these enrolled patients. Clinical, Thoracoscopic findings and histopathological data of the patients were collected prospectively and analysed.Results: Maximum patients were in the age group of 41-50 years. Most common Thoracoscopic finding was multiple nodules (40%) followed by sago grain infiltration (33.4%). Malignancy was the most common HPE finding of pleural biopsy (46.6%) followed by TB (33.3%). All nodules (13) turned out to be malignant while all sago grain appearance pleura (10) turned out of to be TB. The overall diagnostic yield is 80% as a whole and 96% among patients who had thoracoscopic pleural findings.Conclusions: Medical Thoracoscopy is a safe and easy outpatient procedure and an excellent diagnostic tool for undiagnosed exudative pleural effusion. The diagnostic yield is quite high and complications of procedure are negligible

Social Media in Virtual Marketing: Antecedents to Electronic Word of Mouth Communication

Social media usage in the world and especially in Pakistan has a high growth due to which it (social media) has a potential of becoming an effective marketing tool. Despite its compar-atively low cost and significance, marketers are not effectively utilizing social media. Thus the aim of this study is to measure the influence (effect) of four social variables: social capital, trust, homophily and interpersonal influence on electronic word of mouth (eWOM) communi-cation. The sample size for the study is 300 and preselected enumerator's collected the data from the leading shopping malls of the city. Although the scales and measures adopted for this study have been earlier validated in oth-er countries, however the same were re-ascertained on the present set of data. After prelimi-nary analysis including normality and validity the overall model was tested through Structural Equation Model (SEM). This was carried out in two stages - initially CFA for all the constructs was ascertained which was followed by CFA of the overall model. Developed conceptual framework was empirically tested on the present set of data in Pa-kistan which adequately explained consumer attitudinal behavior towards electronic word of mouth (eWOM) communication. Three hypotheses failed to be rejected and one was rejected. Trust was found to be the strongest predictor of electronic word of mouth (eWOM) communi-cation, followed by homophily and social capital. Interpersonal influence has no relationship with electronic word of mouth (eWOM) communication. The results were consistent to earlier literature. Implication for markers was drawn from the results.Keywords: eWOM, social capital, trust, homophily and interpersonal influence, social medi

Tuberculosis: an experience at government chest disease hospital

Background: This retrospective study was carried out to find the incidence, clinical profiles and treatment outcome of pulmonary and extrapulmonary tuberculosis patients attending the only Chest Disease Hospital in Srinagar.Methods: A retrospective analysis of 613 patients having EPTB and PTB was undertaken from the chest disease hospital of Government Medical College Srinagar. Demographic characteristics, clinical features and treatment outcome were obtained from medical case records of all patients visiting the hospital for a period of two years from May 2016-May 2018.Results: The study comprised of 613 patients, out of which 365% were having pulmonary TB while 35% were having extrapulmonary TB. Majority of patients (44.5%) in TB group were in age group 10-30 while majority of patients (42%) in EPTB group were in age group 51-70. Males were seen more commonly affected. Majority (90%) of patients in EPTB group had pleural effusion. Majority of patients (71%) were smear positive by ZN staining in PTB group. Majority (90%) of PTB patients in smear negative group were BAL negative. In PTB group 8% were treatment failure while in EPTB group 2% were treatment failure. MDR was seen in 4.2% of total tuberculosis patient while XDR was seen in 0.32% of total patients. Out of treatment failure in PTB group MDR was seen in 64% followed by monoresistance to INH in 30% and XDR in 6%. In EPTB group MDR was seen in 100% of treatment failure. All patients with XDR died. Among the MDR patients majority are on treatment while 12% died, another 12% defaulter while 12% completed treatment.Conclusions: Among evaluated tuberculosis patients, maximum had PTB. Pleural tuberculosis was the most common presentation of EPTB. The study shows male preponderance in both groups. Treatment response was excellent with failure rate of 8% in PTB and 2% in EPTB. Most common cause of failure was MDR. XDR was seen in two patients and both of them died

An unusual presentation of metastatic adenocarcinoma of lung: a case report

We report an unusual patient with primary adenocarcinoma of lung causing malignant pleural and pericardial effusions. The diagnosis was made only at autopsy as his staging computed tomography scan of chest was negative for an obvious mass lesion within the lung or pleura. Prior to his death, his symptoms were erroneously managed as left ventricular failure and community-acquired pneumonia

Functionalized Multi-Walled Carbon Nanotube-Reinforced Epoxy-Composites: Electrical And Mechanical Characterization

Carbon nanotubes (CNTs) got great attention because of their interesting physical and mechanical properties. Due to these interesting properties observed at the nanoscale have motivated scientific community to utilize CNTs as reinforcement in composite materials. In the present study, different CNTs and epoxy nano-composites with different wt% (1, 2, 3, and 4%) of f-MWCNTs were prepared and their surface morphology and orientation has been investigated in detail. Further, the surface investigation, electrical and mechanical tests were carried out on CNTs-filled and unfilled epoxy at maximum sonication time 30 minute to identify the loading effect on the properties of the materials. Experimental results depicts well dispersion of f-MWCNTs, significant improvement that the resistivity of pure epoxy decreased from 108 .m to average value 103 .m with 1, 2, 3, and 4wt% f-MWCNTs. The 4.5wt% CNTs/epoxy was attributed to poor dispersion of f-MWCNTs in the nanocomposte. The hardness of nanocomposite loading 1, 2, 3, 4wt% of CNTs, increased 20.7%, 23.02%, 25.62%, 29.09% respectively as compared to pure epoxy. We believe that our strategy for obtaining CNT–reinforced epoxy nanocomposites is a very promising technology and will open a new doors in fields of aviation, aerospace, marine and sporting goods

Infective endocarditis in patients with congenitally malformed hearts: characterization of the syndrome in a developing country

Cardiac surgery for correction or palliation of congenital cardiac disease in infancy and childhood remains a privilege that is rarely accessible to two-thirds of the world’s population. This imbalance has created a unique spectrum of illness in patients with underlying congenital cardiac disease and complicating infective endocarditis in developing countries, including Pakistan. In this study, we characterize endocarditis as seen in such patients presenting in Karachi. We reviewed retrospectively patients admitted to Aga Khan University with underlying congenitally malformed hearts and endocarditis between 1991 and 2004. We identified 48 patients with endocarditis according to the modified Duke Criterions, with just over half the cases (54%) classified as definite endocarditis. Of the patients, 23 (49%) patients were more than 16 years old. Uncorrected left-to-right-shunts, tetralogy of Fallot, and congenital mitral valvar disease were the most common underlying defects. Patients with cyanotic defects, particularly of the complex type, were underrepresented (4%). Only 11 (22.9%) of the patients had a previous palliative or corrective surgery. In one-third of the patients (16), streptococcal species were identified as the microbiologic cause of endocarditis, and 22 (45.8%) had culture-negative endocarditis. In contrast, Staphylococcus aureus and enterococci caused endocarditis in only one patient each. There were no differences in mortality or complications between cyanotic and acyanotic congenital defects. Surgery was performed in nine (18.7%) patients with endocarditis, and of these, 13 (27.1%) died. In contrast to the developed world, endocarditis in the developing countries, such as Pakistan, complicates uncorrected left-to-right shunts and tetralogy of Fallot, probably because patients with complex cyanotic defects fail to survive long after birth due to the lack of available surgery. Almost half of patients had culture-negative endocarditis, likely related to several factors

In Vitro Release Studies of Diclofenac Potassium Tablet from Pure and Blended Mixture of Hydrophilic and Hydrophobic Polymers

The purpose of the present study was to evaluate the effect of pure and blended mixtures, with different compositions of hydroxy propyl methyl cellulose (HPMC) and carnauba wax (CW) on the release of diclofenac potassium from matrix tablets. Fifteen different matrix tablet formulations were prepared by direct compression process by using Carver Hydraulic laboratory press having 13 mm flat dies set at constant pressure. The paddle dissolution apparatus II (Curio DL 2020) was used to assess the dissolution of drug in phosphate buffer, pH 7.4 for 8 h. The release data was fitted to different release models. Zoom stereo micrography was done to evaluated the release mechanism of drug from polymers. The interaction of polymer mixture and different ratios of drug in polymer mixture was determined by Fourier transform infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC). The type and content of polymer in the matrix system influenced the release characteristics. Higher polymeric content in the matrix decreased the drug release rate because of increased tortuosity and decreased porosity. Retardation of drug release from pure carnauba was higher as compared to that with pure HPMC matrices. The polymers blends controlled drug release pattern effectively. The drug released showed better linearity with Higuchi release kinetics. The Korsmeyer equation revealed n value ranged from 0.388-0.627 or non - Fickian transport mechanism of drug release was predominant. The FTIR and DSC suggested that there were no chemical interaction between drug and polymers.Colegio de Farmacéuticos de la Provincia de Buenos Aire